AAPM&R Advocacy Win: New CMS Rule Reduces Burden Associated with Prior Authorization

Members & Publications

January 19, 2021

On January 15, the Centers for Medicare & Medicaid Services (CMS) released a new rule: “Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information.”

AAPM&R submitted comments responding to the proposed rule on December 21, 2020. Our comments supported several CMS proposals and offered additional recommendations:

  • We supported CMS’ proposal to require impacted payers include a specific reason for a denial when denying a prior authorization request. CMS finalized this proposal, but with modifications.
  • We supported CMS’ proposal to require impacted payers to send prior authorizations within 72 hours for urgent requests. However, we asked that this timeline be further shortened to 24 hours. CMS finalized the proposal, which will be effective as of January 1, 2024. However, CMS also noted it plans to consider shorter timeframes in future rulemaking.
  • We supported CMS’ proposal to require impacted payers publicly report data about their prior authorization process. CMS finalized this proposal such that payers will report metrics on their prior authorization processes. CMS did not require any specific metrics be included in the final rule.
  • We supported CMS implementing “Gold-Carding” programs. However, CMS was soliciting information on this practice, rather than proposing something specific, so nothing was finalized. CMS said it would continue to learn about gold-carding.

AAPM&R has been leading advocacy for reducing burden associated with prior authorization on Capitol Hill and with CMS for years via comment letters, in-person meetings, and coalition efforts. CMS has even invited us personally to small group in-person discussions to solicit advice on the issue. The proposed and final rules are a direct result of our ongoing advocacy. We will continue to propose new ideas to help reduce burden and give providers more time to focus on caring for their patients.

Read this CMS fact sheet to learn more about the final rule. Read the full text here.


Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.